[Question #1548] Hiv worried and symptoms

44 months ago
Hi, Doctors 

Let me start with my exposure on 1/11/16
Im a male that had vaginal sex with a csw at a massage parlor. I used a condom that she provide as far as I remember I did not notice a condom break when I took it off after 15 min of intercourse.

I did not think about it unill when I got a fever and sore throat on 7/20/16 for about 3 days and started searching online and I thought it was ARS symptoms.

I have taken the Following test:
8/2016 orasure hiv swab test
9/2016 orasure finger prick test
9/2016 4th gen hiv test my doctor
10/2016 4th gen hiv test Labcorp 
10/2016 Hiv RNA test labcorp
11/2016  4th gen hiv test labcorp 
12/12/16 4th gen hiv test QuestDiagnostic

1. If the fever I got on 7/23/2016 was due to hiv. Would any of my test be positive?

2. I have been getting itchy small red bumps in my arms and back. About 2 at a time and and then  go away. Started about 8/2016

3. Is there any other test that you would recommend for Hiv or other Std from the single exposure in 1/11/2016.

5. I have been affraid to have unprotected sex with my GF. Would I be on the clear.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question.

You can stop worrying. For sure you do not have HIV, assuming no new exposures recently that you haven't described. You were seriously overtested. You could have stopped after the first test listed. The HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. That's as long as testing is done sufficiently long after the last possible exposure, which varies from 4 weeks to 3 months, depending on the specific test. All your tests were after those times. Even if you had a high risk exposure (you didn't) or typical symptoms (you did not -- 6 months is far too late for ARS), the test results always overrule exposure history and symptoms.

1) That fever could not have been due to HIV acquired 6 months earlier.

2) Not an HIV symptom.

3) No other tests are more accurate and no more testing is necessary.

4) You could and should have resumed sex with your partner several months ago. For sure you can do so now.

I hope this has been helpful. Best wishes and stay safe--  HHH, MD

44 months ago
Thank you Doctor for your answers It was very helpful.

I would like to ask about what I read on the CDC website: 
"The soonest an antibody test will detect infection is 3 weeks. Most (approximately 97%), but not all, people will develop detectable antibodies within 3 to 12 weeks (21 to 84 days) of infection."

What does the CDC refers to when it states that " Most (approximately 97%) but not all people will develop delectable antibodies within 3 months.

1. Who would fall in the 3% and by when would the other 3% have detectable antibodies?

2. Would there be any other STD test that you would recommend based on the small itchy red bumps that I keep getting in arms and back. I wont see my doctor untill 2 more weeks to ask him about it.

Thank you once again Doctor 
For your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
The CDC statement was written a few years ago, before the 4th generation (antigen-antibody) tests became the norm. As a federal agency, CDC must stick with formal approval by FDA, another federal agency. Scientific evidence supports these tests as conclusive by 4 weeks, but since that's not the official regulatory standard, they can't change it. Anyway, you were tested way beyond 3 months, so what does it matter?

1) Nobody falls in this 3%. Nobody has ever reported any person to have had a negative 4th gen test at 4 weeks who later turned out to have HIV.

2) No STD causes such symptoms. They aren't from the sexual exposure you are concerned about.

44 months ago
I would also like to ask you what would be a normal CD4 percentage range for an HIV negetive person because I took a test just for peace of mind but the lab result range indicates my cd4 percentage is Low at 27%
Everthing else looked normal.

1. Could you give me more information on this?
2. The only reason I took this test was because I thought I would have a rare type of hiv or be rare case and I got a low range of cd4 %

My results: Cd4 percentage  27  % low
Normal range per lab sheet :30-60%

My result Absolute cd4 :548
Normal range: 490- 1740

My results cd8 % suppresor : 25
Normal range: 12-42

My results cd8 absolute: 514
Normal range : 180-1160

Helper suppresor ratio
My results 1.07
Normal range : 0.86-5.00

Absolute lymphocytes : 2018
Normal range 850- 3900

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
It was a mistake for you to have a CD4 test. Such testing should only be done in people with known HIV infection, to evaluate the level of immune suppression caused by HIV. There is no such thing as rare types of HIV not dectected by the standard blood tests; that's an urban myth.

The CD4 and CD8 levels vary naturally and widely, and in healthy persons often are somewhat outside the normal range. But your levels are normal anyway:  it is the absolute numbers that matter, not the percentaages. And your CD4, CD8, helper:suppressor ratio, and lymphocyte counts all are perfectly normal. The barely low CD4% is meaningless.

I hope you'll stop worrying -- and stop spending good money on tests you don't need! And stop searching the internet about all this. If you find yourself still obsessing about this exposure and HIV fears after all the scientific data availalbe and the reasoned, science based reassurance you have had -- probably from your own doctors as well as on this forum -- you may need to seek professional counseling. I suggest it from compassion, not criticism. Your concern about this is far outside normal!

That concludes this thread. Best wishes and stay safe,